Troubleshooting and Quality Control of Equipment and Infection Control
Two jobs in one domain
This domain tests two reflexes: find the cause of an equipment problem fast, and never contaminate a patient or yourself while doing it.
Equipment troubleshooting
Work in order: patient, circuit, machine. Know the alarm logic. High peak pressure with a normal plateau points to increased airway resistance (secretions, bronchospasm, kinked or bitten tube); high plateau pressure points to decreased compliance (pneumothorax, atelectasis, ARDS, abdominal distention, mainstem intubation). Low-pressure or low-volume alarms mean a leak: disconnection, deflated cuff, cracked circuit, or chest tube leak. For oxygen delivery, check analyzer calibration (about 21% in room air, 100% on high FiO2), source pressure, and air-entrainment ports. Measure cuff pressure with a calibrated gauge, targeting roughly 20–30 cm H2O.
Quality control means scheduled verification against a known standard, documented: oxygen analyzers calibrated before use, spirometers checked with a 3-L syringe, blood gas analyzers run with control materials, and preventive maintenance logs kept current.
Infection control
Hand hygiene is the highest-yield answer on any item. Know standard precautions for every patient and transmission-based precautions by route: contact (C. difficile, MRSA), droplet (influenza, pertussis), airborne (tuberculosis, measles, varicella). Don and doff PPE in sequence - gown, mask, eye protection, gloves on; gloves and gown removed first. Distinguish cleaning, disinfection, and sterilization: semicritical items such as bronchoscopes need high-level disinfection, while critical items need sterilization. Drain circuit condensate away from the patient, keep the circuit closed, and change circuits when visibly soiled or malfunctioning rather than on a fixed calendar.
Worked rule
Peak pressure 45 cm H2O with a plateau of 30: the 15 cm H2O difference is resistive. Suction and assess for bronchospasm before you touch ventilator settings.